/ en Sat, 26 Apr 2025 15:02:27 -0500 Wed, 15 Apr 20 09:56:35 -0500 /protect-heroes <div id="article"><img alt="health care workers wearing PPE" src="/sites/default/files/2020-04/TT_0420_protecting_heroes_900.jpg" /> <h4 class="articleKicker"><a href="/resource-repository-trustees?topic=5172">COVID-19</a></h4> <h1>AHA and Partners Launch ‘Protect the Heroes’ Campaign</h1> <h3 class="articleDeck">Save those who are saving us</h3> <p>The Creative Coalition, Association for Healthcare Philanthropy, and the AHA launched the <strong><a href="/press-releases/2020-04-07-protect-heroes-launches-direct-support-local-hospitals-health-systems-and" target="_blank">“Protect the Heroes”</a></strong> campaign, which allows the general public to make direct impact donations to America’s hospitals and health systems. Every dollar raised from Protect the Heroes goes directly to the donor’s choice of local hospital to purchase personal protective equipment and other support for their local health care workers to fight the novel coronavirus (COVID-19).</p> <p>Individuals can visit <strong><a href="https://protecttheheroes.org/" target="_blank">ProtectTheHeroes.org</a></strong> and be connected to the website of a local hospital of their choosing and contribute to the hospital's emergency relief funds. Each hospital will determine where funds should be applied.</p> <p>“In recent weeks we have seen an outpouring of support from Americans eager to help our nation’s health care heroes on the front lines of COVID-19,” said AHA President and CEO Rick Pollack. “This initiative is about making a difference directly in communities and providing immediate support for our brave women and men on the front lines of this pandemic.”</p> </div> Wed, 15 Apr 2020 09:56:35 -0500 Trustee Articles /making-community-health-improvement-heart-and-soul-governance <div id="article"><img alt="Lancaster General Health Farmers Market" src="/sites/default/files/2020-04/TT_0420_scanlan_lgh_900.jpg" /> <h4 class="articleKicker"><a href="/resource-repository-trustees?topic=504">Population Health</a>   I   <a href="/resource-repository-trustees?topic=5172">COVID-19</a></h4> <h1>Making Community Health Improvement the Heart and Soul of Governance</h1> <h3 class="articleDeck">Governance lessons learned from a health system committed to improving community health</h3> <h4 class="articleByline">By Carolyn F. Scanlan</h4> <h3 class="topicBox">Viewpoint</h3> <p>Population health. Community health. Social determinants of health. These are key components of the framework that leading hospitals and health systems are building to raise the quality of life, health and well-being in the communities they serve.</p> <p>Many boards are aware of these components and the work their health care organizations are doing to address them, often with the help of other community partners. However, their connection to this work may occur only episodically — for example, when the board reviews the level of uncompensated care their organization provides and the community health improvement work it does each year, as part of the board’s oversight for state and federal community benefit requirements and reporting.</p> <p>As boards focus on traditional issues of assuring a high level of quality clinical care, services and financial performance, community health issues are becoming equally important. Penn Medicine Lancaster General Health (LGH) in Lancaster, Pa., believes that these fundamentals are enhanced by effective community and population health integration.</p> <p>At LGH, we also believe this work is meaningful and creates true benefit for communities. Yet, boards may find themselves asking what their role should or could be if continuously improving the quality of health and well-being of their communities is the heart and soul of the organization and its governance.</p> <p>As vice chair of the LGH board, I have seen the results that can be achieved when continually improving community health is part of the DNA of the organization and its board. Our commitment to this work started decades ago, and the lessons we have learned can help other organizations and boards committed to continuous improvement of community health.</p> <h3>The Lancaster General Health Story</h3> <p>LGH is composed of a 507-bed teaching hospital, 97-bed women and babies hospital, a 59-bed rehabilitation hospital, a 126-bed behavioral health hospital and 18 outpatient facilities throughout Lancaster County. These facilities are supported by 58 primary and specialty-care physician practices, school- and community-based clinics, and other care and teaching programs.</p> <p>Because Lancaster County does not have a public health department, a variety of community organizations work together to focus on community health improvement. In 1990, LGH and more than 30 community partners joined forces to establish a health collaborative called LiveWELL Lancaster County Coalition. Every three years, LGH and LiveWELL consolidate their health assessments into one countywide assessment and work together to prioritize and address significant health needs. In 2016, the county’s top three health needs were mental health and well-being, obesity and substance abuse — ranging from tobacco use to opioid use disorder. The LGH 2016–2019 strategic plan adopted these priorities and in addition focused on key social determinants of health that underlie them: disparities, poverty and access to care. More than 80 initiatives were developed to address these priorities. Annually, our organization provides nearly $100 million in community benefit funding to support the work of community partnerships and care for patients with income up to 400% of federal poverty level guidelines.</p> <p>Our chief executive officer and community-led board of trustees guide and oversee our organization’s community benefit priorities. The Mission and Community Benefit Committee of the board provides oversight for all community benefit activities, establishes our local health priorities and monitors the health status of the communities we serve. The LGH board vice chair historically has chaired this committee, underscoring this leadership commitment. LGH's executive leaders actively participate on numerous community boards of directors and coalitions to address the issues that challenge our community, modeling and supporting this commitment for all employees.</p> <p>LGH’s Community Health and Wellness Department carries out the work of the board’s Mission and Community Benefit Committee and collaborates with community groups to develop community health needs assessment (CHNA) findings. Improvement strategies are developed and tailored to meet specific needs through work with city and county agencies and critical partners such as federally qualified health centers, free clinics and social service providers. Additionally, LGH operations and service lines are aligned and incorporate the CHNA and health priorities.</p> <p>LGH has integrated its health priorities into the work of our primary care practices (patient-centered medical homes), Care Connections and regional care teams. While LGH has been working on community health needs for decades, during the past five years the health system has tightly integrated this work into its care delivery models. LGH believes that this is what differentiates it from other community health efforts. LGH primary care physicians screen for such things as depression, smoking, food insecurity, housing needs, utilities issues, transportation needs and interpersonal violence. As a result of this screening, LGH can make immediate referrals and provide needed services. For instance, LGH offers integrated behavioral health counselors at its primary care practice sites for immediate psychological and emotional support, which can lead to “warm handoffs” to regional safety-net hubs created with the United Way. In addition, screening for food insecurity has led LGH is introduce a “Food Farmacy” program for individuals with limited access to healthy food.</p> <p>As one of the largest health systems and safety nets in the county, LGH has taken a leadership role in establishing and facilitating numerous countywide coalitions that focus on improving health at the individual, family, community and societal levels. The health system provides programs and services to those in need, and works strategically with community partners to influence policy, systems and environmental solutions that ensure lasting change.</p> <p>Three principles continue to guide LGH’s commitment:</p> <ul> <li>Partnerships are powerful.</li> <li>Partnerships are built on trust.</li> <li>Measure project impact and share results.</li> </ul> <h3>Outcomes and Lessons Learned</h3> <p>Lancaster County consistently ranks among the top 10 healthiest counties in the state of Pennsylvania. In 2018, LGH received the AHA’s Foster G. McGaw Prize for Excellence in Community Service, an important milestone on our ongoing journey toward better health for our community. This recognition has helped us reflect on the lessons we have learned on our journey thus far.</p> <p>Of most importance is our commitment to community health improvement — and to making this work a part of the organization’s and board’s DNA, rather than viewing it as a collection of projects or initiatives. This is essential because it takes decades to influence community health priorities and requires that community health is built into the organization’s ongoing strategic priorities.</p> <p>The importance of working through partnerships cannot be overestimated. Partnerships are the foundation of all our community benefit initiatives. We understand that LGH alone cannot have a meaningful, sustainable impact on improving community health and well-being. We also have learned that operating within a sociological framework that addresses policies, systems and environmental solutions is key to long-term sustainable impact.</p> <p>It is critical for hospitals and health systems committed to this work to recognize they are on a journey that has no end. Our 2019 community health needs assessment identified the following areas of greatest need:</p> <ul> <li>access to care;</li> <li>family-sustaining incomes;</li> <li>accessible transportation;</li> <li>affordable and quality housing; and</li> <li>safety from violence and adverse childhood experiences.</li> </ul> <p>Interventions to address these needs over the next decade include:</p> <ul> <li>Focusing on root causes of poor health.</li> <li>Strengthening community partnerships.</li> <li>Leveraging the full resources and influence of LGH to create change, by becoming an anchor organization that provides significant financial investment and purchasing emphasis in the community as well as other support for community health improvement.</li> </ul> <p>At LGH, we recognize there is always more to do to improve community health, and the most important question we must continue to ask ourselves is, “What’s next?”</p> <h4><span>Carolyn F. Scanlan</span> (<a href="mailto:cfscanlan@gmail.com">cfscanlan@gmail.com</a>) is vice chair of the board of Penn Medicine Lancaster General Health in Lancaster, Pa., and chair-elect of the ���������� Association’s Committee on Governance.</h4> <p><em>Please note that the views of the author do not always reflect the views of the AHA.</em></p> </div> Tue, 14 Apr 2020 14:33:15 -0500 Trustee Articles <div id="article"><img alt="trustee working from home" src="/sites/default/files/2020-04/TT_0420_orlikoff_covid_governance_900.jpg" /> <h4 class="articleKicker"><a href="/resource-repository-trustees?topic=554">Transforming Governance</a>   I   <a href="/resource-repository-trustees?topic=5172">COVID-19</a></h4> <h1>Effective Governance During the COVID-19 Pandemic</h1> <h3 class="articleDeck">Staying ahead of the COVID-19 crisis curve</h3> <h4 class="articleByline">By Jamie Orlikoff</h4> <h3 class="topicBox">Viewpoint</h3> <p>Much is being written about the impact of the novel coronavirus (COIVD-19) on hospitals and their caregivers and how they can effectively respond to the pandemic. What about governance during this emergency? Will it be business as usual? The emphatic answer is no. Boards can add tremendous value to their systems and hospitals during this crisis and provide crucial support to their executives. They must take care not to add unnecessary administrative burden. This article highlights a variety of specific policies and practices that boards can consider adopting now to stay ahead of the COVID-19 crisis curve.</p> <p class="number-list"><strong>1. Pass emergency spending resolutions to increase limits on CEO discretionary spending.</strong> Most organizations have clear limits on the amount the CEO can spend, and going above that limit requires specific board approval. If a situation arises that requires such spending in the middle of the COVID-19 crisis, it is likely to be an emergency requiring immediate action, and going through the process to convene a meeting of the board will be time consuming. There also is a concern that many board members could fall ill. Pass this resolution now.</p> <div class="articleSidebar floatRight"> <h4>RELATED RESOURCE</h4> <p></p> <h5>PODCAST</h5> <h3>Governance in the Time of Coronavirus: What governing boards should do to respond to the pandemic</h3> <p>Governance expert Jamie Orlikoff presents a brief on-demand podcast outlining issues and actions that boards should consider for their organizations to stay ahead of the pandemic leadership curve, as well as anticipate and prepare for unprecedented situations and challenges.</p> </div> <p class="number-list"><strong>2. Pass a resolution to approve authority to apply for waivers of Section 1135 of the Social Security Act.</strong> On March 13, 2020, President Donald Trump declared a national emergency under the National Emergencies Act and made an emergency determination under the Stafford Act. This allowed the authorization of waivers of certain Medicare, Medicaid, and Children’s Health Insurance Program (CHIP) requirements under Section 1135 of the Social Security Act. On that same day, the Centers for Medicare and Medicaid Services (CMS) announced a set of waivers specific to the COVID-19 pandemic. Boards should ask their executive management team whether they need to apply for specific waivers and adopt broad authorization to obtain them, if that’s what your corporate bylaws call for.</p> <p class="number-list"><strong>3. Develop an emergency executive succession plan.</strong> What happens if your CEO and other chief executives become incapacitated with COVID-19? Require your CEO to develop an emergency executive succession plan that goes multiple layers deep. This plan should immediately be shared with the board along with contact information of all possible interim CEOs. Likewise, the contact information for board officers and members should be shared with all possible interim CEOs.</p> <p class="number-list"><strong>4. Assure the board can function.</strong> As the <a href="/system/files/media/file/2019/06/aha-2019-governance-survey-report_v8-final.pdf">2019 AHA National Governance Survey</a> data show, most boards are largely composed of members who are in age groups that are at greater risk of serious illness if diagnosed with COVID-19. Questions to consider now: What happens if the chair of the board and the board officers fall ill at the same time? Who will be the point person with the CEO? Who will speak for the board to the community and media? Who will have the authority to convene and preside at an emergency meeting of the board? Develop a deep emergency interim board leadership succession plan that assumes your board may need to appoint new officers on very short notice. Decide now who these interim board leaders will be, to save time later and maintain board continuity should the worst happen.</p> <p class="number-list"><strong>5. Make certain the board can act with diminished numbers.</strong> Emergency meetings of the board may be required to take unprecedented, but necessary, board action. Review your board meeting quorum requirements and consider adopting emergency resolutions to reduce them if they are too high to ensure your board can legally act with diminished numbers. Confirm the legal ability of your board to meet and act by phone or virtual means, and adjust the requirements to provide maximum flexibility.</p> <p class="number-list"><strong>6. Rethink the executive committee.</strong> Many boards have been moving away from having an executive committee. This can be a best practice in “normal” times, but these are not normal times. If your board does not have an executive committee or has one with a very limited scope of authority, consider creating an emergency, time-limited executive committee with delegated board authority. If you have an executive committee, review its authority and confirm it can act appropriately on behalf of a “disabled” board.</p> <p class="number-list"><strong>7. Review your rules, procedures and logistics for convening an emergency board meeting.</strong> Pay attention to who can call a meeting; the length of the required notice period; minimum quorum requirements; and limitations on topics that can be addressed and actions that can be taken during the meeting. Determine what decisions require a super-majority vote of the board. Consider passing emergency, time-limited amendments as necessary to assure governance nimbleness.</p> <p class="number-list"><strong>8. Support the CEO.</strong> Many CEOs are pulling double or triple duty during this pandemic, leading their organizations while also being involved in state and national hospital association and other external activities. Anticipate a time when your organization is under such pandemic surge pressure that it will be “all hands on deck” and require 100% of your CEO’s time. Consider imposing bans on travel and limiting the CEO’s time spent on outside boards and activities. Provide appropriate board cover for executives to enable them to focus on leading your organization through the pandemic.</p> <p class="number-list"><strong>9. Ensure leadership.</strong> Many hospitals and system executives in peak COVID-19 hotspot areas take pride in rounding in patient care areas to “show the flag” to caregivers, and to be visible leaders. While laudable and indicative of true leadership, what happens if the entire executive team falls ill at the same time? Ask your CEO to designate an “executive in reserve,” someone who is asked to isolate themselves, not do rounding, and to only participate in executive team and other meetings by virtual means. Act to ensure that if the executive team falls ill, at least one member will still be available to lead.</p> <p class="number-list"><strong>10. Reduce the governance burden on executives.</strong> Board and committee meetings take a significant amount of executive time to prepare for, attend and follow up. Now is not the time to inundate your executives.</p> <ul> <li>Postpone or cancel noncritical board and committee meetings.</li> <li>If you must have board meetings: Replace in-person meetings with conference calls or video conference meetings; streamline the agenda to contain only items of immediate importance and to reduce meeting length; maximize use of consent agendas; and use unanimous consent resolutions via email when possible.</li> <li>During the crisis, many board members will want to help, or ask for information and updates. While well intended, this consumes executive time and attention when it is best devoted elsewhere. Create an interim policy requiring that all board member communication to the CEO, executives and clinical leaders go through the board chair (or appropriate board committee chair). The board chair can then triage the requests for information, helpful suggestions and concerns, and then determine which should be communicated to management, when and how.</li> <li>Both the strengths and weakness of human nature will emerge during this crisis. Anticipate that board members with sick loved ones may call the CEO or clinical leaders imploring for special access to tests, treatment, N95 masks, ventilators or medications. Develop a policy that addresses this. Think carefully about if a strategic case can be made for key board leaders to be tested or treated in a way that helps maintain leadership capability, but this should be a board discussion and decision. It should not be left to the CEO to decide whether to grant a favor to a board member in the heat of a critical moment. Strongly consider a policy that prohibits board member requests for special favors, tests, treatment or equipment.</li> </ul> <p class="number-list"><strong>11. Plan for caring with limited resources.</strong> The pandemic is placing unprecedented demands on America’s entire health care system. As the number of patients needing acute hospital care rapidly increases, hospitals may be challenged with significant shortages of staff and medical supplies such as personal protective equipment (PPE), hospital beds, medicines and medical devices such as ventilators. Hospitals are doing everything possible to enhance the availability of the vital tools and resources needed to care for patients during this pandemic. However, at times during the pandemic, front-line clinicians and hospital leaders may face extraordinarily challenging decisions about how to deploy limited staff and material resources. The board should make certain that policies and protocols for delivering care under extraordinary resource constraints have either been established or are under development now. Once developed, the policies should be approved by the board to provide organizational support for physicians and caregivers and to relieve their stress burden, both in the moment and in the future. Make certain that such difficult, and even unthinkable, decisions are supported at the system level, and not forced on individual physicians or caregivers.</p> <p class="number-list"><strong>12. Implications for systems with subsidiary hospital boards.</strong> Many systems with subsidiary hospital boards have delegated authority to these boards, and this could easily inhibit efficient decision-making in critical situations. Review these specific subsidiary hospital board authorities to identify areas that potentially conflict with likely necessary future system board decisions relating to the pandemic. These may include amending credentialing requirements; triage and rationing decisions; emergency consolidation of capacity (e.g., one hospital in the system dedicated to COVID-19 patients, another dedicated to “routine” emergencies, labor and delivery, and other patient care, for example). Amend these subsidiary board authorities now to ensure necessary system decisions can be made quickly when the time comes.</p> <p>Boards must think and act now to make the unprecedented and challenging decisions necessary to minimize the many disruptions that are just around the corner of the COVID-19 pandemic.</p> <h4><span>Jamie Orlikoff</span> (<a href="mailto:j.orlikoff@att.net">j.orlikoff@att.net</a>) is president of Orlikoff & Associates, Inc., a consulting firm specializing in health care governance and leadership, and is the national advisor on governance and leadership for the ���������� Association.</h4> <p><em>Please note that the views of the author do not always reflect the views of the AHA.</em></p> </div> Wed, 08 Apr 2020 08:17:08 -0500 Trustee Articles <div id="article"><img alt="business woman in mask" src="https://trustees.aha.org/sites/default/files/2020-04/TT_0420_woman_mask_900_1.jpg " /> <h4 class="articleKicker"><a href="/resource-repository-trustees?topic=554">Transforming Governance</a>   I   <a href="/resource-repository-trustees?topic=5172">COVID-19</a></h4> <h1>Board Guidelines for a Time of Crisis</h1> <h3 class="articleDeck">The board’s role during the COVID-19 pandemic</h3> <h4 class="articleByline">By Karma H. Bass and Brad D. Clarke</h4> <h3 class="topicBox">Viewpoint</h3> <p>As health care organizations step up to the challenge of the novel coronavirus (COVID-19) pandemic, the need for a governing board to effectively fulfill its role as overseer of the organization has never been more critical. But determining specifically what board members should and should not be doing during a time of crisis can be difficult. The following guidelines identify actions and behaviors your governing board members should undertake—or avoid—during the pandemic.</p> <ol> <li><strong>Govern, don’t manage.</strong> As tempting as it may be to be active in managing the crisis, board members must remember their roles as overseers, not operators. Getting involved in operations—e.g., requesting involvement in a crisis management meeting or asking for too much information from a CEO—only adds to the executive leadership’s burden and runs the risk of crossing the line between governance and management.</li> <li><strong>Trust the executive team.</strong> Although a first inclination may be to contact the CEO frequently, the board must trust that the executive team and staff are taking appropriate steps to manage the crisis and will reach out to the board when the team requires oversight involvement.</li> <li><strong>Stay connected.</strong> The board chair can play an essential role in staying connected with the CEO and conveying information to other board members. The chair and CEO should establish basic ground rules for communication and designate a preferred method for receiving and sending urgent communication. For example, the CEO and the board chair may agree that communication that is urgent and requires a response will be delivered via text, while communication that is more informational and does not require a response or an immediate response will be delivered via email. The CEO and board chair also should agree on the cadence of regular communication—e.g., weekly, every other week—between the CEO and the board during the crisis. For some boards, a weekly email update from the CEO throughout the crisis strikes the right balance.</li> <li><strong>Do not act as a public spokesperson.</strong> Board members are not hospital spokespersons and should decline national and local requests for comment on a hospital’s practices, challenges or crisis management updates. Requests should instead be directed to the hospital’s media relations, public relations or communications department, as appropriate. Concerns or complaints about a hospital service should be directed to a patient advocacy department.</li> <li><strong>Be respectful of staff time.</strong> Hospital support staff are trained to respond to requests by the board promptly and efficiently. The board should minimize work that a staff may need to do to prepare for a board meeting and also delay asking questions that are neither urgent nor related to the crisis to another time.</li> <li><strong>Expedite clinician privileging.</strong> In some areas, the pandemic is causing a surge of patients, overburdening the medical staff. Board members should be willing to approve an expedited privileging process to support onboarding of community physicians who are not on staff at the facility.</li> <li><strong>Advocate.</strong> Advocacy is a main responsibility of the board and even more important in times of crisis, as health care organizations may require additional funds to obtain resources and maintain operations. Board members should consider sending requests for emergency fund relief to their elected officials.</li> <li><strong>Promote the use of telemedicine/virtual care.</strong> While interacting with family, friends and those in the community, board members should encourage the use of virtual care, as available, to help relieve the impact on emergency rooms. The board should receive appropriate links explaining the steps for a virtual provider visit, for example, so they can pass this information along to others.</li> <li><strong>Leverage community resources.</strong> Board members should use their local relationships to obtain access to and donations of resources urgently needed to provide care, such as protective masks, tents for setting up services outside facilities, or childcare for hospital staff who are putting in extra hours.</li> <li><strong>Be aware of community needs.</strong> If a board member learns of a specific community need, the member can deliver that message to a hospital staff member, such as the board liaison, who then will deliver the request to the appropriate department representative.</li> <li><strong>Lead by example.</strong> Most board members are high-profile community members who can act as role models for appropriate behavior during a crisis. For instance, by practicing social distancing during the pandemic, board members can foster behavior that will greatly serve their communities.</li> <li><strong>Solicit contributions.</strong> The number of community members requiring financial assistance during the pandemic may quickly accelerate. Board members can leverage their connections to ask for funds to help the organization’s community assistance emergency funds.</li> <li><strong>Do not leverage the board role for preferential treatment.</strong> As members of the community who use health care services and have family and friends who do so, board members face the temptation to use their roles to obtain preferential treatment. Board members must respect the organization’s operational processes for fair treatment of all community members. They also must remember that hospital staff are still required to adhere to strict patient confidentiality and information protocols during the pandemic.</li> <li><strong>Acknowledge leadership and caregivers.</strong> Hospital executives, providers and other staff are putting their lives in danger to manage the crisis and care for others. Something simple like a formal thank-you letter from the board acknowledging the dedication of leadership and employees can help boost strength and commitment.</li> </ol> <p>Overall, during the COVID-19 pandemic, the board should refrain from overwhelming leadership and staff with questions and overstepping into a management role. In times of crisis, the main role of the board is to be supportive of the organization’s efforts and ready to help when asked.</p> <h4><span>Karma H. Bass</span> (<a href="mailto:kbass@viahcc.com">kbass@viahcc.com</a>) is a principal at Via Healthcare Consulting based in Carlsbad, Calif. Brad D. Clarke (<a href="mailto:bclarke@viahcc.com">bclarke@viahcc.com</a>) is a senior consultant at Via Healthcare Consulting based in Lexington, Ky. The authors would like to thank Pam Arledge, senior manager, executive operations, Providence Health & Services, Olympia, Wash., for her contribution to these guidelines.</h4> <p><em>Please note that the views of the author do not always reflect the views of the AHA.</em></p> </div> Tue, 07 Apr 2020 12:29:18 -0500 Trustee Articles <div id="article"><img alt="illustration of video conferencing" src="/sites/default/files/2020-04/TT_0420_video_conference_900_2.jpg" /> <h4 class="articleKicker"><a href="/resource-repository-trustees?topic=554">Emerging Issues</a>   I   <a href="/resource-repository-trustees?topic=5172">COVID-19</a></h4> <h1>What Hospital Board Members Need to Know: A Seven-Point Framework for Navigating COVID-19</h1> <h3 class="articleDeck">Critical issues to consider during the pandemic</h3> <h4 class="articleByline">By Anne L. Rooney</h4> <h3 class="topicBox">Viewpoint</h3> <p>The novel coronavirus (COVID-19) pandemic has placed unprecedented stress on the U.S. health system. The exceptional speed at which the pandemic has grown demands that every community across the country be as prepared as possible to receive and care for patients with COVID-19.</p> <p>Hospital and health system boards have the fiduciary responsibility to ensure that emergency preparedness plans, processes and resources are in place to effectively respond to this extraordinary crisis. In navigating these uncharted waters, what are the most critical issues for boards to consider? This seven-point framework identifies the major components for leadership, discussion and decision-making.</p> <h3>1. Ensure that an effective emergency preparedness plan is in place.</h3> <p>The board’s initial role is to ensure that an emergency preparedness plan is in place and fully funded. The CDC provides an excellent <a href="https://www.cdc.gov/coronavirus/2019-ncov/downloads/HCW_Checklist_508.pdf" target="_blank">hospital preparedness checklist</a>.</p> <p>The board’s role should focus on setting policy and strategy, while also ensuring appropriate resources. Hospital management should determine the details and ensure effective execution.</p> <p>The board, along with senior management, sets the overall organizational tone in addressing this pandemic. Leadership must strike a balance between a positive, yet realistic, message to all key stakeholders, including the community at large. Board members can have a profound impact at this critical time by being calm, appreciative and supportive of the work being carried out by their organizations.</p> <h3>2. Ensure effective infection identification, management and prevention.</h3> <p>The board ultimately oversees hospital quality and safety, including infection prevention and control. Response to the pandemic requires the hospital to ensure its staff is trained, equipped and capable of practices needed to promptly identify, isolate, and provide care for suspected or confirmed COVID-19 patients; monitor and manage any staff and visitors who may be exposed; and prevent the spread of the disease within the facility.</p> <h3>3. Ensure that an effective crisis communication plan is in place.</h3> <p>The hospital should have its own crisis communication plan as well as actively participate in one that is communitywide. Having a plan in place that links all the key players ensures that critical minutes aren’t wasted, or worse, that inaccurate information is disseminated. Hospital management should provide regular updates to the board.</p> <p>Rumors in a community can abound and result in unnecessary panic and missteps. In order for the community to hold trust in the hospital, it is critical that hospital leadership communicates accurately and transparently, while still respecting patient privacy concerns.</p> <p>Board members will be asked questions by the public or by local news media; however, there should be one designated hospital communications spokesperson or small team in place to consistently communicate the hospital’s message. Board members should refer all questions to the identified person or team.</p> <h3>4. Ensure a safe, healthy and sufficiently trained workforce.</h3> <p>A top priority is to maintain a trained and healthy workforce. Hospitals and health systems throughout the country are focused on providing adequate personal protective equipment (PPE) in order to protect their staffs and prevent spread of the coronavirus.</p> <p>Far-reaching implications of the pandemic response – including “shelter in place” orders, closures of schools and businesses, and job loss − have added to the stress that health care personnel face. Management may recommend that the hospital adopt new policies and practices to support the hospital's workforce. Examples include:</p> <ul> <li>Offering additional psychological, emotional and spiritual support for staff.</li> <li>Providing temporary living accommodations for some staff.</li> <li>Designating “time out” or sleep rooms for staff.</li> <li>Augmenting clinical staff with nontraditional hospital personnel to assist with nonclinical activities.</li> </ul> <h3>5. Ensure ethical management of scarce resources.</h3> <p>Accepting an influx of patients with COVID-19 will likely require the hospital to prioritize the care to other patients, including those services and types of procedures that can be deferred and specifying for how long and with what consequences.</p> <p>In some circumstances, not all patients in need of intensive care will be able to be accommodated in the intensive care unit. The hospital may need to plan for alternative sites to provide critical care within the hospital, such as the catheterization lab, operating rooms or the post-anesthesia care unit.</p> <p>One of the biggest challenges that many hospitals will inevitably face is establishing objective criteria and clinical guidelines for making decisions regarding the management of patients competing for scarce resources, including resuscitation. Some hospitals are even discussing the feasibility of a universal do-not-resuscitate policy for COVID-19 patients or other guidelines that permit physicians to override patient or family wishes regarding resuscitation on a case-by-case basis.</p> <p>The objective criteria used to make decisions about allocation of scarce resources must be created in advance, formally adopted by both the medical staff and hospital leadership, and then approved by the board.</p> <h3>6. Understand the financial implications and hospital leadership’s response.</h3> <p>Hospitals and health systems are experiencing an immediate threat to their financial resources. Whether related to the short-term impact of canceling procedures and elective surgeries, reduced investment income from the market downturn, increased costs associated with obtaining crucial supplies, or longer-term economic issues, hospitals and health systems will likely face significant fiscal impacts. Even with regulatory action, the crisis is likely to threaten the financial sustainability of some hospitals and health systems.</p> <p>The board and its finance committee need to understand these critical financial implications and how hospital leadership is addressing the challenge, such as through proactive cash flow projections, an evaluation of a credit line, and a careful review of the budget as well as strategic and operational plans.</p> <p>During times of crisis and economic insecurity, it is particularly important for hospital and health system governing boards to keep the public trust, an asset no board can do without. In the oversight of hospital finances, boards are held accountable to the people in the communities they serve.</p> <h3>7. The “look back”: Evaluate the hospital’s emergency response, then recalibrate.</h3> <p>The governing board’s role in a pandemic does not end once an immediate crisis has subsided. When life is returning to normal, the board should participate in thoroughly assessing the hospital’s response. As with any crisis, some things will have gone according to plan and some will not. The board needs to understand the “lessons learned” as well as potential opportunities for improvement, and then assure that these opportunities are addressed by management.</p> <h3>The Challenge Ahead</h3> <p>COVID-19 will undoubtedly be the most serious test of our hospitals’ and overall health care system’s ability to respond to a crisis of unprecedented proportions. Hospital and health system boards play a critical role in assuring that plans, policies, processes and resources are in place and ready to meet this great challenge. Critical too is the importance of a strong voice by boards and board members, advocating on behalf of their organizations to elected officials for the needs of their organizations and the people they are privileged to serve.</p> <h4><span>Anne L. Rooney</span> (<a href="mailto:contact@governWell.net">contact@governWell.net</a>) is an advisor with the health care governance consulting firm governWell.</h4> <p><em>Please note that the views of the author do not always reflect the views of the AHA.</em></p> </div> Tue, 07 Apr 2020 12:24:54 -0500 Trustee Articles